From the information you provide, you may have a condition called functional hypothalamic amenorrhoea (FHA). This is a condition often seen in women who are very lean, and often have high energy expenditure (generally from over-exercising). It results from changes in hormone levels in the hypothalamus (in the brain) that usually control a woman's ovulatory cycle. Basically, the physical state of being of low body mass is a sort of physiological stress that causes the brain to shut down ovulation.
Please note that FHA is a sort of "diagnosis of exclusion", and it would be important for you to under assessment, examination and investigation by a specialist to exclude other causes of amenorrhoea. Generally, a gynaecologist or endocrinologist would be your best bet. The following information is intended in a general context only, and should not be seen as specific advice to your situation.
The main problem with FHA is a low oestrogen level. This may cause symptoms such as increased hair loss, sleep disturbance, mood disturbance, vaginal dryness (which may cause discomfort with sex), reduced libido, etc. The lack of oestrogen also means a lack of a menstrual period, as ovulation is not occurring. This, therefore, is the mechanism of infertility with FHA.
An important consequence of FHA and low oestrogen is bone loss. This can lead to irreversible osteoporosis in very young women. Contrary to popular misconception, is that the loss of bone from low oestrogen is not compensated by the positive effects of exercise on bone mass - not even close. The "Pill" will mask the effects of FHA - by causing a regular period and covering up symptoms of low oestrogen, however the underlying problem is not addressed and, obviously, the Pill does not help with fertility issues. Generally, however, the Pill does not adequately guard against bone loss, and women with FHA should also be taking supplemental calcium and vitamin D.
In short, I would agree with your dietitian - FHA is a big issue.
With regards to fertility, the good news is that ovulation can be restored with optimisation of weight / body mass. Although your current BMI (18.9) may be considered "normal" by some reference ranges, it is still relatively underweight (<20), and I would expect most women to resume normal menstruation once their BMI increases over 20. This is generally achieved with increased caloric intake and reduced energy expenditure (less exercising). This is not always practical (e.g. professional athletes training for the Olympics) and, in those cases, use of the Pill and calcium/vitamin D should be encouraged for bone protection.
While there are fertility treatments that can induce ovulation in FHA, it is always appropriate to attempt correction of the underlying issue first, since a healthy pregnancy also requires a healthy body weight and nutritional status. Along with your specialist, Dietitians are very valuable in the management of FHA and, in some cases, the expertise of a Psychologist may be beneficial.
Although I am not aware of any lasting fertility issue directly due to FHA, I would expect that, the longer a woman's lifestyle is conducive to FHA, the harder it may be for her to make the appropriate changes to restore normal ovulatory function, within a timeframe that she finds suitable.
Obviously your particular circumstances will influence your next move. However, I think at least having a consultation with a Gynaecologist and/or Endocrinologist, in addition to regular review with your Dietitian, will go a long way to helping you avoid any lasting consequences of FHA, and help you optimise your body weight and health.
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